CMS Price Transparency Data

Blood transfusion

Facility: Decatur Memorial Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,024
Cash Discount Price: $2,114
vs. Medicare Baseline: 2.27x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Decatur Memorial Hospital is $1,024. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,114. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.27x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$2,114

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,024

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$450.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $450.73 (100%)

Cash / Self-Pay: $2,114 (469%)

Insurance Median: $1,024 (227%)

Cash: $2,114 (469% of Medicare)

Ins. Median: $1,024 (227% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $450.73 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 227% of the Medicare baseline (a markup of 127%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$43 - $1,692	10%
Blue Cross Blue Shield	$43 - $2,522	10%
Coventry	$43 - $1,513	10%
Health Alliance	$43 - $1,677	10%
Humana	$43 - $1,639	10%
Medicare (plans)	$43 - $465	10%
UnitedHealthcare	$43 - $2,522	10%
Veterans Administration	$43 - $465	10%
Tricare	$44 - $473	10%
Illinois Workers Compensation	$126 - $908	28%
Medicaid / KanCare	$426 - $1,706	95%
Wellcare	$465	103%
Hfn	$706 - $1,892	157%
Commercial Workers Compensation	$714 - $862	158%
Mennonite Churches	$734 - $1,084	163%
Plain Church Medical Group	$768 - $1,135	170%
Health Alliance Mh Employee Plan	$785 - $1,160	174%
Cigna	$795 - $1,175	176%
6 Degrees Health	$1,024 - $1,513	227%
Hopetrust	$1,024 - $1,513	227%
Hst	$1,024 - $1,513	227%
Caterpillar	$1,064	236%
Phcs Savility	$1,109 - $1,639	246%
Phcs Multiplan Ppo	$1,160 - $1,715	257%
Healthlink	$1,170 - $1,730	260%
Corvel	$1,228 - $1,816	272%
Consociate	$1,262 - $1,866	280%
Liability	$1,706 - $2,522	378%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $2,114.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 36430.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Decatur Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 36430.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.